Cordotomy
A vocal fold cordotomy is a safe, reliable and relatively simple endoscopic laser procedure used to treat glottic airway stenosis caused by bilateral vocal fold paralysis (BVFP).
Indications/Contraindications
Respiratory distress from BVFP. Patients may undergo this operation whether or not they have already undergone a tracheotomy.
This operation may be less successful in the case of bilateral vocal fold mechanical fixation since there is more of a propensity for the airway to stay narrow given the absolute lack of movement of the arytenoids.
Endoscopic exposure of the larynx is mandatory to perform this procedure.
In the Clinical Setting
Key Points
The cricoarytenoid joint should be palpated during operative endoscopy as arytenoid fixation can be mistaken for BVFP.
A unilateral cordotomy is highly effective in the treatment of dyspnea due to BVFP and much less effective in cases of posterior glottic stenosis (mechanical fixation of the arytenoids).
If the airway remains inadequate postoperatively, a contralateral cordotomy may be performed.
Laser safety precautions are mandatory.
Pitfalls
Complications include granuloma, scarring, perichondritis, and vocal fold edema that may necessitate revision or tracheotomy.
A revision cordotomy may be necessary if the lateral extent of the cordotomy falls short of the cricoid cartilage, or if the surgical defect subsequently fills in.
Permanent voice alteration as a result of this procedure should be emphasized to the patient preoperatively.
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